Getting Device Codes Added to CPT's in Chargemaster

jwmorris1

I was wondering if anyone had a good process to ensure that new device codes are getting attached to the CPT codes in your CDM. I am new to this role. Currently our business office software is alerting HIM Coding that a device code is required prior to billing. A recent example was pacemaker leads needing to be added to the pacemaker insertion CPT.

Looking forward to hearing what others do.

Thanks,

Jeff

lisa longo

Jeff:

I currently utilize a CDM product that assists me with this process.  Many of the manufacturing devices can be searched within that CDM product and matched via manufacturer number.  The product also allows for e-mail requests as part of the process. Within this request functionality, the manufacturer product information is a requirement.  There are the times that this information is not available within the product.  I have found that some suppliers, such as Medtronic and Boston Scientific, will offer coding information on their products via the Internet.  A few have reimbursement documents available.  I also utilize the web to search the product to see how it is used.  Seeing the item will give me the general idea of what the item does and its usage (e.g. implant, wire, rods, orthotic, etc.)  

We have a process at our facility for the clinical department or Materials Management to supply all manufacturing information, which will allow you to search the web. place a call to the company to try to get this information, or access this information through the CDM vendor product.

Work with your billing department to confirm which payers will require HCPCs based on Revenue Code.  For the most part, supplies are typically packaged and the Revenue Codes, 270, 271, 272 will not require a HCPC, although some HCPC Codes will be assigned the code 272.  The items falling withing Revenue Code 274, 275, 276 and 278 should have HCPC.   Also, pay close attention to any payor contracts that might have extra or higher reimbursement for high cost implants.  These will need to be coded properly to receive that add on or higher payment and, most likely, specific coding requirements will be required as well as invoicing.  

The Internet can be a great resource to getting to this information without having an actual CDM vendor product.

Lisa

debs0906

You may also want to work with your billing staff to see if stop edits can be put in place for those procedures that require a device. Medicare has a list of device dependent procedures that requires a device be on the claim or they will return it to the provider. The problem is, it could be the incorrect or less costly device that meets their edit criteria and you could still miss out on reporting the high dollar device. We are building the list into an editor at our site that will stop the claim if the main device is not on the claim, i.e. the pacer C code with a pacemaker insertion procedure CPT.

trosi

We do what debs0906 references.  Our claims will stop in Epic if the procedure requires a device.  The account is then sent to our Rev Integrity team to be added... and we then in turn work to get the HCPCS added to the CDM.